Association of Pseudoexfoliation With Systemic Vascular Diseases in a South Indian Population

Abstract

IMPORTANCE Ocular pseudoexfoliation (PEX) syndrome may be associated with systemic vascular diseases, which might suggest a broader health significance of PEX, although previous reports are conflicting.OBJECTIVE To determine whether prespecified vascular risk factors and cardiac abnormalities are more common among patients with PEX than among control individuals without PEX. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional analysis of patients recruited into the Aravind Pseudoexfoliation study included South Indian patients older than 40 years with or without PEX who required cataract surgery. Surgical procedures were performed at 4 tertiary Aravind eye hospitals in Tamil Nadu, India, from December 2, 2010, through March 26, 2012. Nine hundred thirty patients with PEX and 476 non-PEX controls underwent detailed ocular examinations, including specific ocular features reflecting PEX. Patients also underwent evaluation for multiple systemic potential cardiovascular diseases and their risk factors. The data collection for this analysis on systemic vascular diseases started on December 2, 2010, and ended on April 30, 2014. This study analysis was specified in the study protocol. MAIN OUTCOMES AND MEASURESFive cardiovascular outcomes compared between patients with and without PEX included blood glucose, cholesterol, and homocysteine levels; blood pressure; and cardiac morbidity (defined by electrocardiographic [ECG] abnormalities). RESULTSThe study analysis included 930 patients in the PEX group and 476 in the non-PEX group. The mean (SD) ages of patients in the PEX and non-PEX groups were 64.8 (6.8) and 59.9 (7.3) years (P < .001), respectively. More patients in the PEX group were men (470 [50.5%] vs 460 women [49.5%]) than in the non-PEX group (201 [42.2%] vs 275 women [57.8%]; P < .001). In multivariable analyses adjusting for age and sex, higher systolic blood pressure values were noted for the PEX group (difference [Δ], 4.0 mm Hg; 95% CI, 1.7-6.2 mm Hg; P = .001). Also, patients in the PEX group were more likely to demonstrate an ECG abnormality than in the non-PEX group (odds ratio, 1.64; 95% CI, 1.04-2.60; P = .03). Pseudoexfoliation was not observed to be associated with a higher level of blood glucose (Δ, 6.2 mg/dL; 95% CI, −2.0 to 14.3 mg/dL; P = .14), serum cholesterol (Δ, −0.6 mg/dL; 95% CI, −5.1 to 4.0 mg/dL; P = .81), or serum homocysteine level (Δ, 0.004 mg/L; 95% CI, −0.12 to 0.14; P = .96).CONCLUSIONS AND RELEVANCE Of the 5 cardiovascular outcomes examined in South Indian patients requiring cataract surgery, PEX was associated with higher systolic blood pressure and more frequent ECG abnormalities but not with higher blood glucose, serum cholesterol, or serum homocysteine levels. Patients with PEX are more likely to require attention to blood pressure and cardiac morbidity.

Link of ocular pseudoexfoliation syndrome and vascular system changes: results from 10-year follow-up study

“…The tendency of higher rates of cases of new IHD and ischemic ECG changes was found in the PEX group when compared with the group of subjects without the PEX. The same was confirmed by other investigators [16].…”

“…Various pathogenetic mechanisms have been postulated to explain the higher risk for vascular disease in patients with the PEX, including the deposition of the PEX material in blood vessels, increasing vascular resistance, and vascular dysregulation. Insults to the vascular endothelium and smooth muscle function by the PEX deposits have also been postulated as a mechanism for atherosclerosis and thrombus formation, which could lead to cardiac events [14][15][16]. The prevalence of the PEX has been found to be 0.2-30.0% regardless of geographical features.…”

Posttranscriptional Regulation of LOXL1 Expression Via Alternative Splicing and Nonsense-Mediated mRNA Decay as an Adaptive Stress Response

“…[24][25][26] In agreement with a previous study, 24 IL-6, and homocysteine had no significant effect on expression levels of LOXL1 and LOXL1-a. This observation together with inconsistent clinical reports on plasma homocysteine levels in patients with PEX, which are elevated in many but not in all study populations, 57 suggests that hyperhomocysteinemia may not be causally involved in PEX pathophysiology, but may only serve as a biomarker or innocent bystander of disease. 58 Stress-induced inhibition of NMD by UV-B light, oxidative and mechanical stress was shown to depend on eIF2a phosphorylation, which represents a critical step in NMDcoupled stress response.…”

Recent advances in risk factors associated with ocular exfoliation syndrome

“…All anterior segment structures may be affected by the presence of XFS materials, thus, potentially resulting in several clinical and surgical complications (Ashok Vardhan et al 2017;Erkayhan & Dogan 2017;Ilveskoski et al 2018;Kurt & Yas ßar 2018). Although not believed to increase mortality, XFS is thought to impair normal eye functions (Ringvold et al 1997;Shrum et al 2000;Grodum et al 2004;Slettedal et al 2015;Svensson & Ekstrom 2015).…”